The following information is requested to assist and guide our Licensing Department to fairly judge an applicant's ability and resources to develop a Double Cola bottling plant/distributorship and achieve maximum sales of Double Cola products throughout the requested territory.
All information will be held in the strictest confidence.

Date
*

Exact Legal Company Name
*

Company Name

Address
*

Street Address

City

State / Province

Postal / Zip Code

Country

Telephone
*

-
Area Code Phone Number

Fax

-
Area Code Phone Number

E-mail
*

Federal ID#
*

State Tax ID#
*

Date Company Founded
*

State of Incorporation
*

Type of Company
*

Sole ProprietorshipPartnershipCorporation

Please state the complete names, title, age, and percent ownership of the company's principals and/or officers:

Owner/Officer Name

Title

Age

% Ownership

1.

2.

3.

4.

List key Management or Supervisory Personnel, title, age, and total years of soft drink experience.

Name

Title

Age

Years Experience

1.

2.

3.

4.

What is the number of full-time employees in your organization:

Admin

Marketing

Sales Supervision

Warehousing

Production

Pre-salesmen

Route/Delivery

Other Sales

Total
*

If you are planning to have sales centers, branches, or depots, identify these locations and branch manager's name:

Location

Branch Manager's Name

1.

2.

3.

State below important business or supplier relationships:

Name

Address

Contact Person

Bank(s)

Others

List products that you currently sell and whether you produce them yourself:

Brand Name

Product Description

Annual Volume

Produce (Yes/No)

1.

2.

3.

4.

5.

6.

What is the total number of delivery routes that you plan to operate:

Direct Route Sales

Pre-Sell

Tel-Sel

1.

Please generally describe your intended fleet of distribution and service vehicles (and indicate number in fleet):

Number

Mfg./Type

Body Type

Ton Capacity

Average Age

1.

2.

3.

4.

Describe your present facility:

Land Size

Building Size

Age

Owned or Leased?

# Loading Docks:

Truck Drive Thru (Yes/No):

1.

If you do not now produce or sell soft drinks or new age beverages, describe any previous soft drink or beverage experience:

List the counties and accompanying states for the territory you are requesting a Distribution Agreement:
*

List the number of distribution outlets by type for soft drinks in the territory for which you are requesting a Distributorship Agreement and show the number you are presently servicing:

Total Number

Now Servicing

Supermarkets or Chain Stores

Grocery and Food Stores

Mass Merchandisers

Other

Convenience Stores

Vending Locations

Other

Do you have vending, cooler, or pre/post-mix business?
*

YesNo

If so, give approximate number of units and number purchased during the last 12 months:

Number Owned

Purchased 12 Mos.

Vending Machines - Bottle

Vending Machines - Can

Coolers - Glass Door

Coolers - Chest Type

Pre-Mix Units

Post-Mix Units

If granted a Distribution Agreement, what are your specific plans for development of the territory requested (packaging, pricing, promotion, marketing strategy, etc.)?
*

If granted a Distribution Agreement, how do you propose to obtain and structure the management of the soft drink and/or new age beverage operation?
*

Why do you want to become a bottler or a distributor of Double Cola Company products?
*

If granted a Distribution Agreement, are you prepared to identity your fleet and merchandising equipment with our logo?
*

YesNo

How do you propose to finance or invest in this project?
*

EquityLoan

If the Distribution Agreement is granted, how soon do you expect to be able to begin distribution of our products?
*

Give your projections of annual case sales for the territory for each of the brands for which you are requesting a Distribution Agreement:
*

Year 1

Year 2

Year 3

DOUBLE-COLA

DIET DOUBLE-COLA

SKI

SKI FLAVORS

CHASER

JUMBO FLAVORS

MINOKU

QUAD

ZILI

DOUBLE-DRY

Please provide any other information you feel appropriate or that would assist us: